what is menopause
ceasing of periods due to lower hormone levels
when
45-55
not had a period for at least 12mths - not using contraception
perimenopause = having symptoms before periods stop
symptoms - flushing, brain fog, mood swings, anxiety, irregular periods - can start yrs before periods stop and carry on after
symptoms
vasomotor - sweats and flush
msk - joint and muscle pain
effects on mood - low mood
urogenital - vaginal dryness
sexual dysfunction - low libido
managing symptoms
vasomotor = HRT
- if patient has a uterus - would need P and O for endometrial protection, can be monthly or cyclical
- if patient still has periods - cyclical, then usually switched to continuous
no uterus/ has mirina coil - O only
SSRI, SNRI can also be given, and clonidine
urogential atrophy
- vaginal oestrogen - topical, even if on HRT
would not need P for topical oestrogen - vaginal
oestogens
estradiol
estrone
estriol
ethinylestradiol
menastranol
progestogens
desogestrel
medryprogesterone
norethisterone
levonorgestrel
risks of HRT
VTE-
- risk increased by HRT - both combines and O only increases risk
- risk is greater in oral vs transdermal
- increases with other general risk of VTEs
CHD
- increases CV risk in women over 60
stroke
- when started in women over 60
- oral - not transdermal with small risk of stroke
breast cancer
- HIGH risk in combined over O only
- longer exposure - increases risk, stays for 10 plus years after
endometrial cancer
- women with uterus - risk lower with combined
- also increased with tibolone
ovarian cancer
- small risk, disappears few yrs after stoppingr
regimens
monthly cyclical - O daily, P at end cycle for 10-14 days
three monthly cyclical - O daily, P for 14 days every 13 week
continuous = O AND P daily
Menopausal - any of three
perimenopausal - cyclical
SURGERY
elective- stop HRT 4-6 weeks before
reinitiate - when fully mobile
non elective
prophylactic heparin
graduated compression stockings
when HRT would be stopped
JAUNDICE - or symptoms of liver issues, abdo pain, red urine, fatigue, itchy skin, NV etc
increase in BP
new onset Migraine type headache
pregnancy
VTE
CNS effects - prolonged headache, fainting, epileptic seizure, motor, numbness
prolonged immobility
